During speech air moves from our lungs over the two vocal cords. These are in the larynx, or voice box, which is in the front of the throat, at the level of the Adam's apple. If one, or both, of the vocal cords is damaged or if the nerves which work them are injured, then this can cause a hoarse, very weak, voice or even complete loss of the voice. The nerves which work the vocal cords run through the chest to reach the voice box and so some chest illnesses, including cancer, may cause a hoarse voice.

A hoarse voice can be due to a number of different conditions. Although most of these turn out not to be cancers and are completely benign and safe it is important that if there is cancer it is diagnosed and treated as soon as possible. Therefore, if your hoarse voice does not go back to normal within a week or two it is something you should not ignore and just hope will get better on its own - you should go and see your family doctor (GP).

The Department of Health has recently given guidelines to general practitioners about people who come to them with a hoarse voice that has lasted more than a few weeks. These say that they should either arrange an immediate chest x-ray or an urgent appointment with a specialist.

The chest x-ray should be done within a day or two and an urgent hospital appointment usually means that the specialist will see you within two weeks.

If a chest x-ray is done and this suggests there could be a cancer, then your doctor will arrange an urgent appointment with a specialist.

When the specialist sees you they will take your full medical history and carry out a careful physical examination. The specialist will probably do other tests which may include:

• passing a tiny flexible telescope (nasendoscope) through your nose in order to look at your larynx and the vocal cords (sometimes this is done under a general anaesthetic rather than in the out-patient clinic)
• taking a sample of phlegm (sputum) to look at under the microscope
• passing a narrow flexible tube down your throat into the lungs to look at the air passages and possibly take some tiny samples of tissue (biopsies) for examination. This is called a bronchoscopy and might be done either under a local anaesthetic as an out-patient or under a general anaesthetic
• a special type of x-ray test called a CT-scan which can often give more information than an ordinary chest x-ray.

If these tests do show that there is a cancer on the vocal cords or in the chest then further treatment might involve an operation to take it away or radiotherapy or chemotherapy may be given, depending on the exact type of the cancer and its size.

Cancers of the vocal cord are very curable, especially if it they are caught early, so if you have developed a hoarse voice for more than a week or two don't delay - go and see your doctor.